Overview
The goal of this study is to examine changes in cognitive functioning and post-concussive symptoms following hyperbaric oxygen therapy (HBOT) in current and former first responders with a history of traumatic brain injury. The main questions it aims to answer are:
- Do cognitive functioning and post-concussive symptoms change after 40 HBOT sessions?
- Do symptoms of PTSD, depression, and anxiety, or quality of life, change after treatment?
Approximately 54 participants will:
- Complete medical and behavioral health screening.
- Complete cognitive tests and questionnaires before and after treatment.
- Receive 40 HBOT sessions at 2.0 atmospheres absolute (ATA), twice daily with at least four hours between sessions.
All participants will receive HBOT. There is no comparison group, so the study cannot determine whether HBOT caused any observed changes.
Description
This prospective, single-arm study will examine changes in cognitive functioning and post-concussive symptoms following hyperbaric oxygen therapy (HBOT) in approximately 54 current or former first responders with a history of traumatic brain injury (TBI). Secondary outcomes include symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety, as well as quality of life.
After providing informed consent, participants will undergo medical and behavioral health screening to determine eligibility for HBOT. Eligible participants will complete baseline cognitive testing and questionnaires measuring post-concussive symptoms, psychological symptoms, and quality of life. These assessments will be repeated after treatment.
Participants will receive 40 HBOT sessions in a multiplace chamber at 2.0 atmospheres absolute (ATA). Each session will include two 30-minute periods of breathing 100% oxygen separated by a 5-minute air break. Sessions will take place twice daily, Monday through Friday, with at least four hours between sessions. A physician will prescribe and oversee treatment, and trained hyperbaric personnel will operate the chamber and monitor participants.
Changes between baseline and post-treatment assessments will be analyzed within participants. The study will also explore whether demographic or clinical characteristics are associated with the magnitude of change. All participants will receive HBOT; there is no randomized or untreated comparison group. As a result, the study can describe changes observed following treatment but cannot establish that HBOT caused those changes.
Eligibility
Inclusion criteria
- Adults aged 18 to 75 years.
- Current or former first responder.
- Clinically diagnosed with a traumatic brain injury (TBI) and current or persistent post-concussive syndrome, as determined by a qualified health care professional.
- Participants with comorbid PTSD, depression, or anxiety may be enrolled if all other eligibility criteria are met; these symptoms will be assessed as secondary/exploratory outcomes.
- Ability to provide informed consent, including the ability to read, understand, and voluntarily sign the informed consent document.
- Completion of baseline cognitive and psychological assessment measures as part of study enrollment procedures.
- Presence of clinically significant symptoms resulting in functional impairment in occupational, social, or other key areas of functioning, as determined by clinical evaluation.
- Sexually active female participants of childbearing potential and sexually active male participants with female partners of childbearing potential must agree to use an acceptable method of contraception for the duration of the study and for 30 days following the final HBOT session.
- Stable regimen of psychoactive medications (if applicable), including antidepressants, anxiolytics, antipsychotics, stimulants, and mood stabilizers, for a clinically appropriate stabilization period prior to enrollment, as determined by the study physician.
Exclusion criteria
- Untreated pneumothorax
- History of spontaneous pneumothorax
- Severe sinus infection
- Upper respiratory infection
- Asymptomatic pulmonary lesions on chest x-ray
- Uncontrollable high fever (greater than 39C)
- History of chest or ear surgery
- Congenital spherocytosis
- Any anemia or blood disorder
- Any convulsive disorder
- History of optic neuritis or sudden blindness
- Middle ear infection
- Diabetes mellitus (insulin therapy)
- The participant is pregnant or lactating
- Nicotine use/substance use/addiction
- Acute Hypoglycemia
- Diagnosed Chronic Obstructive Pulmonary Disease (COPD) and Emphysema
- Presenting with symptoms of cough, congestion, vomiting, diarrhea, or open wounds.
- Active malignancy
- Current manic, delusional, or psychotic episodes
- Serious/current suicidal ideations
- Severe or unstable physical disorders or major cognitive deficits
- Inability to attend scheduled clinic visits or comply with study protocols.
- Treated with HBOT for any reason prior to study enrollment.
- Non-English speakers
- History of retinal repair, including laser photocoagulation or retinal detachment surgery.
- History of middle ear surgery, including tympanoplasty, mastoidectomy, or pressure equalization tube placement.
- Age greater than 75 years.
- Use of any of the following medications during the study period: Anti-metabolites (e.g., methotrexate, azathioprine); Chemotherapuetic agents (e.g., cyclophosphamide, cisplatin); Mafenide acetate e.g., Sulfamylon); Disulfiram (e.g, Antabuse); Peripheral vasodilators known to interact with oxygen exposure (e.g., nitroglycerin); and Antibacterial drugs with known HBOT interaction risks.
